BBI Contributing Writer

DALLAS, Texas – Wireless LAN was a popular theme at this year's Healthcare Information and Management Systems Society (HIMSS; Chicago, Illinois) conference here, as hundreds of vendors were showing applications run on wireless platforms. Proxim (Mountain View, California); Cisco Systems/Aironet (Akron, Ohio), Symbol Technologies (Holtzville, New York), Lucent Technologies (Basking Ridge, New Jersey), and Ameranth Wireless Systems (Vienna, Virginia), a Symbol Technologies partner, were showing wireless LAN infrastructures, including PCMCIA transceivers, wireless access points, and other components of the wireless health care infrastructure of the future.

Wireless LANs operating at 2.4 GHz that complied with IEEE 802.11b were everywhere, and while they work well in isolation, having both direct sequence and frequency hopping users in the same place, all transmitting at the same time, created Internet access problems for the entire HIMSS conference for a time. This underscores the issue that Direct Sequence Spread Spectrum (DSSS) is more prone to interference and not as reliable as frequency hopping spread spectrum units. As a result, many of the traditional suppliers of DSSS are expanding their product lines to include frequency hopping radios. For example, Symbol Technologies – known for DSSS – was showing its newest frequency hopping designs at HIMSS, better positioning it to compete with Proxim (Mountain View, California), a company known for its work in frequency hopping.

The approaches of these two companies are interesting to compare. Proxim is an open supplier of just the radios, which integrate into whatever computing platform desired, while Symbol is the leader in integrated platforms that contain scanners and has a patent on that combination. Symbol Technology focuses mostly on proprietary, integrated platforms that include the RF radios. While traditionally a supplier of direct sequence radios, Symbol was showing some interesting hand-held computers that integrated IR, RF frequency hopping SS, and Windows on a 133 MHz platform. Indeed, the new Micropaq from Protocol Systems (Beaverton, Oregon) uses a Symbol frequency hopping radio and this platform for its portable nurse central station PDA. While this computer platform may not be fast enough to process the most demanding medical applications itself, if used in a thin-client workstation in a Citrix/WinFrame configuration, it would be able to handle most types of medical applications that can be run on its limited-sized display. Proxim works mostly through a network of more than 800 value-added retailers (VARs), while Symbol prefers to provide direct application support. Thus, the companies have very different approaches to the market, and abilities to provide local support. Each, however, is moving into the other's traditional market space with both products and service strategies.

Proxim is working actively to integrate cellular phone and wireless network, via an alliance with Siemens, which will make Siemens' 2.4 GHz phones compatible with Proxim networks. Rather than 802.11b compliance, Proxim is betting on the approval of Home RF standards by the FCC, particularly now that industry heavyweights – including Intel, Microsoft, Hewlett-Packard, and Compaq – all are supporting it. If approved, it would support 3 MHz to 5 MHz-wide slices of spectrum, which is wide enough for some medical applications, according to Proxim. This type of networking is already in widespread use in non-U.S. geographies. Home RF has the potential for incorporating the rival Bluetooth networking as well, since Bluetooth is a lower-cost subset of the Home RF approach. If approved by the FCC, medical application developers would have a 10 Mbps frequency hopping network as an alternative to the current, slower 1.6 Mbps frequency hopping networks that exist today. This would allow frequency-hopping approaches to compete on a data rate basis with the faster, but less reliable, 11 Mbps direct sequence spread spectrum incorporated in the IEEE 802.11b standard. This would eradicate the speed "penalty" of frequency hopping (compared to direct sequence) for medical applications, and make frequency hopping the technology of choice for medical.

Wireless LAN is clearly a technology that will be ready for prime time in health care this year, as long as users choose a frequency hopping technology vendor, or can assure that they don't install both DSSS and FH in the same facility. Of the direct sequencing products, the Cisco Systems products were impressive, offering a fail-safe design. At less than 120 feet from an access point, you get full 11 Mbits/second data rates. Move a bit further away and the data rate drops automatically to 5.6 Mbits/second. Still further away and the data rate drops to 2 Mbits/second (at around 300 feet). This is quite adequate for health care use, in all but picture archiving and communications systems (PACS) applications as long as multiple, direct sequence systems are not installed in the same facility. Cisco plans to offer new network products operating at 5.6 GHz frequencies that support much higher data rates across the network by mid-2001. These products, however, would consume 30 mw of power, making them too power hungry for most battery-operated, patient-worn devices, but just fine for portable monitors that are line-operated most of the time and have higher capacity batteries during transport/mobile applications. These also will be implemented as PCMCIA devices, making any computing device with a PC card slot a viable candidate for networking in the 5.6 GHz band.

Brisk business in 'medicalized' computers

Vendors of "medicalized" computers were reporting robust interest and sales. Tremont Medical (Aston, Pennsylvania) reported that its product sales were up, even before HIMSS. Judging by the activity at the Planar (Hillsboro, Oregon) and Datalux (Winchester, Virginia) booths, interest in their units was up as well. LXE (Norcross, Georgia) was showing an interesting cart-enabled laptop computer, called the Mobile Clinical Work Station. This was for laptop computers that need to be mobile, and had a slimmer form factor than some competitive carts, and a smaller price tag as well. The LXE cart was height-adjustable and had a pull-out keyboard of normal size to enhance typing (compared to using the laptop's keyboard). If coupled with a modern 500 MHz or faster laptop with a 15.1-inch active matrix display, it would provide all the computing power needed for most medical applications. However, the product configuration shown was only a 266 MHz model that was already technologically obsolete.

Walkabout Computers (Singer Island, Florida) was showing its Hammerhead series of rugged, portable, pen-based systems, ranging in price from $2,500 to more than $4,000. Neither heat, nor cold, nor moisture, nor knocks will bother this highly-configurable computer. There were even some new palm and hand-held devices from HP and NEC running the newest version of Windows CE (2.0).

Even traditionally low-tech suppliers like GCX wall mounts were showing mounting systems for information technology components. Meanwhile, vendors like Micron (Boise, Idaho), Compaq, Walkabout Computers, Sun Microsystems (Phoenix, Arizona), Gateway Computers (Lake Forest, California), Intel (Beaverton, Oregon), and others were showing off the latest crop of consumer-based laptop and Jupiter-class portables. NEC America (Irving, Texas) was showing its computer components and in-hospital wireless telecommunications. These phones are ideal for staff communications and operate in an unlicensed frequency (1920-1930 MHz) in which there are no interfering signals, and can therefore transmit low power (10 MW – about 1/100th the power of a conventional cell phone) and still have reliable, hospital-wide cellular communications. NEC already has begun to integrate with nurse call systems, via its partnerships with providers like DuKane Corp.

NEC has a phone on a PCMCIA card that will be available in the U.S. market shortly. This device will fit very well with the hospital-of-the-future vision of many health care planners. With the addition of a little custom Windows CE application software, it will allow a Windows CE device with two PC card slots to host both the NEC card for reliable voice communications and a 2.4 GHz frequency hopping, spread spectrum PCMCIA card for reliable wireless LAN connectivity to the patient monitoring and hospital information networks – both in a hand-held package that is convenient for caregivers to carry with them. This is part of a convergence of devices and technologies that is rapidly occurring, which will become an enabling technology for future medical devices. It overcomes a major limitation of the cellular telephone approach to voice and internet, which is channel bandwidth and interference due to high-power cellular phones in the medical environment. NEC also has a personal handset systems phone in Japan that provides wireless Internet integration with its normal handset functions. This technology is likely to appear in the U.S. market within a year, offering an alternative to 2.4 GHz cellular technology to merge these two modalities. It allows hospitals to spread wireless applications over more frequency spectrums, thus reducing interference.

IR locators/bidirectional pagers

Executone's (Milford, Connecticut) booth featured its integrated phone message/infrared (IR) locator systems. Now installed in more than 250 hospitals, Executone has some data to demonstrate the cost-effectiveness of these systems, particularly for biomedical engineering, housekeeping, radiology, pharmacy, dietary, transport, and other medical applications. The system has been enhanced to integrate with hospital-wide ethernet LAN that already is in place in all hospitals in version 5.0 of the ILS software. Spacelabs (Redmond, Washington) was one of the first to use this technology with its patient monitoring systems. Agilent Technologies and GE Marquette also offer IR location technology using a competitor's products. The cost of this infrastructure is coming down, and as it becomes more integrated with wireless communications, the value relationship will improve. Widespread implementation can be expected over the next five years.

Several companies showed bidirectional pagers. Wireless MD (Woodstock, Georgia) was offering units that allowed MDs to see abnormal lab values and drug problems of their patients in real-time. Wireless MD has an alliance with Labcorp, a leading national laboratory, and is using its 700+ sales people to present this alternative reporting mechanism to the 275,000 physicians in office practice with which it already has relationships. Rental of the pager and notification service runs about $90 a month.

Integration is the name of the game, according to newcomer Virtmed (Cambridge, Massachusetts). In its evening panel presentation and discussion, featuring providers from the University of Michigan (Ann Arbor, Michigan) and Hartford Hospital (Hartford, Connecticut), as well as a representative of the Gartner Group (Stamford, Connecticut), there was general consensus that physicians, at least, were not likely to carry three or four specialized electronic devices around, or even two, but wanted all the functionality integrated into one portable, palm-sized device. Not surprisingly, that is exactly what the Virtmed product facilitates. The company's contribution is the integration of information at the enterprise level, and conversion of it into datastreams that are compatible with, and displayable on palm-sized devices, like the popular 3-Com PalmPilots, or one of the many Windows CE-based equivalents, which are not yet as popular or in such widespread use. Of course, Microsoft aims to fix that with a summer upgrade to Windows CE, making it more capable, robust, and giving it better application development tools. For those whose applications happen to be older, legacy, and web-ignorant, Netsteps (Hoffman Estates, Illinois) – or any of two dozen similar vendors – will web-enable even the oldest applications still operational in some dark corner of a health care enterprise.

Continued growth spurt

This year's HIMSS convention continued the organization's tradition of "bigger and better." It drew approximately 6% more total attendees than last year's gathering, and within the professional-level attendee subcategory, the number of CIOs jumped 27%. Based on final day registration data, about 17,300 people from around the globe attended the four-and-a-half-day conference. Professional-level attendees – those with CEO, CFO, CIO, COO, director/department head, and other senior management level titles – also posted a 25% increase over the previous year. CIOs accounted for 700 attendees within the subcategory total.

The number of companies exhibiting at this year's conference also was up substantially, increasing some 31% to 640 total exhibitors. About 300 companies already have pre-selected some 60% of the 324,000 gross square feet of exhibit space that will be available at the society's Feb. 4-8, 2001, conference and exhibition in New Orleans, Louisiana.

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